title: Judging pain in infants: behavioural, contextual, and developmental determinants.
abstract: Caretakers intuitively use various sources of evidence when judging infant pain, but the relative importance of salient cues has received little attention. This investigation examined the predictive significance for judgements of painful discomfort in preterm and full-term neonates of behavioural (facial activity and body movement), contextual (invasiveness of the procedure), and developmental (gestational age) information. Judges viewed videotapes showing infants varying in the foregoing characteristics undergoing heel incisions for routine blood sampling purposes. Findings indicated all but the contextual information contributed uniquely to judgements of pain, with facial activity accounting for the most unique variance (35%), followed by bodily activity and gestational age, each accounting for 3% and 1% of the judgmental variance, respectively. Generally, 71% of the variance in ratings of pain could be predicted using facial activity alone, compared to 30% of the variance using bodily activity alone, 19% by relying on context alone, and 8% by referring to gestational age alone. Noteworthy was the tendency to judge early preterm infants to be experiencing less pain even though they were subjected to the same invasive procedure as the older infants. This finding also runs counter to evidence from developmental neurobiology which indicates that preterm newborns may be hypersensitive to invasive procedures.
authors.affiliation: Regina Health District, Regina, SK, Canada Department of Psychology, 2136 West Mall, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada Department of Paediatrics, University of British Columbia, Vancover, BC, Canada Newborn Care, British Columbia Children's Hospital, Vancouver, BC, Canada.
authors.forename: Heather D
authors.initials: HD
authors.lastname: Hadjistavropoulos
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Craig
authors.forename: Ruth Eckstein
authors.initials: RE
authors.lastname: Grunau
authors.forename: Michael F
authors.initials: MF
authors.lastname: Whitfield
mesh_terms: D001519:Behavior / Q000502:physiology*; D002657:Child Development; D003463:Cues; D005069:Evaluation Studies as Topic; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015588:Observer Variation; D010146:Pain / Q000503:physiopathology / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods*; D012044:Regression Analysis; D014743:Videotape Recording